A 26-year-old male complains of difficulty breathing and has SpO2 94% on room air. What is the most appropriate initial action?

• A. transport him for evaluation.
• B. assist his ventilation.
• C. question him about why he doesn’t have his medication.
• D. administer oxygen.

Answer: (D)

Ensuring adequate oxygen delivery is the priority in respiratory distress. A SpO2 of 94% on room air is on the edge of normal, but the patient is having difficulty breathing, so the first action is to provide supplemental oxygen to improve oxygenation and reduce the work of breathing. Start with a nasal cannula at a low flow (often 2–4 L/min) and titrate up to keep SpO2 at or above about 94% (or as your local protocol dictates). If the patient remains in distress or cannot tolerate a nasal cannula, switch to a higher-delivery device such as a nonrebreather mask at 10–15 L/min.

While administering oxygen, continue to monitor vital signs, oxygen saturation, mental status, and work of breathing, and be prepared to escalate care if signs of hypoventilation or deterioration appear. Asking about medications or planning transport are important but do not address the immediate need to correct potential hypoxemia; ventilation assistance is only needed if there is inadequate ventilation or failure of oxygenation despite optimization.